title: Reliability of subjective wound assessment.
abstract: BACKGROUND
  Assessment of the take of split-skin graft and the rate of epithelialisation are important parameters in burn surgery. Such parameters are normally estimated by the clinician in a bedside procedure. This study investigates whether this subjective assessment is reliable for graft take and wound epithelialisation.
  
  
  METHODS
  Observers involved in the field of burns (experienced, medium-experienced and inexperienced observers), and dermatologists specialized in the field of wound healing evaluated the percentage graft take and epithelialisation in 50 photographic skin-grafted burn wounds. Reliability was tested using the intraclass correlation coefficient (ICC).
  
  
  RESULTS
  Intra- and interobserver reliability of parameter graft take was highest within the experienced observers (ICC average > 0.91), followed by medium- and inexperienced observers (ICC average > 0.80 and ICC average > 0.68). Parameter epithelialisation showed the same pattern of intra- and interobserver ICC scores (experienced > medium > inexperienced). Interobserver ICC single scores of the experienced group were reasonable to good. Interobserver reliability of the dermatologists was similar to medium-experienced observers.
  
  
  CONCLUSIONS
  Our data show that one experienced observer can obtain adequate reliable results by means of a single assessment of graft take and epithelialisation. Furthermore, experience of the observer results in an increase of reliability.
authors.affiliation: Association of Dutch Burn Centres, Beverwijk, The Netherlands.
authors.forename: M C T
authors.initials: MC
authors.lastname: Bloemen
authors.forename: P P M
authors.initials: PP
authors.lastname: van Zuijlen
authors.forename: E
authors.initials: E
authors.lastname: Middelkoop
mesh_terms: D002056:Burns / Q000473:pathology* / Q000601:surgery; D004848:Epithelium / Q000469:parasitology; D006085:Graft Survival; D006801:Humans; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015203:Reproducibility of Results; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D014945:Wound Healing